XT. End-of-Life Interview

XT. End-of-Life Interview Module of SHARE 2015

Label Type Description
XT104 Question IWER:note sex of decedent (ask if unsure)
XT001 Question [{Name of the deceased}] has participated in the SHARE study before [his/her] death. [His/Her] contribution was very valuable. We would find it extremely helpful to havesome information about the final year of [{Name of the deceased}]'s life. All the information collected is strictly confidential, and will be held anonymously.
XT006 Question IWER:Code proxy respondent's sex.
XT002 Question Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased?
XT003 Question IWER:Specify other relative
XT004 Question IWER:Specify other non-relative
XT005 Question During the last twelve months of [his/her] life, how often did you have contact with [{Name of the deceased}], either personally, by phone, mail, email, or any other electronicmeans?
XT007 Question Can you tell me your year of birth?
XT101 Question Let us now talk about the deceased. Just to mak e sure that we have the correct information about [{Name of the deceased}], can I just confirm that [he/she] was born in[{Month and Year birth of deceased}]?
XT102 Question In which month and year was [{Name of the deceased}] born?MONTH:YEAR:
XT103 Question In which month and year were [{Name of the deceased}] born?MONTH: ______YEAR:
XT008 Question We would lik e to k now more about the circumstances of [{Name of the deceased}] 's death. In what month and year did [he/she] pass away?MONTH:YEAR:
XT009 Question In what month and YEAR did [he/she] pass away?MONTH: ______YEAR:
XT010 Question How old was [{Name of the deceased}] when [he/she] passed away?
XT109 Question Was [{Name of the deceased}] married at the time of [his/her] death?
XT039 Question NUMBER OF CHILDREN THE DECEASED HAD AT THE END
XT011 Question What was the main cause of [his/her] death?
XT012 Question IWER:Specify other cause of death
XT013 Question How long had [{Name of the deceased}] been ill before [he/she] died?
XT014 Question Did [he/she] die ...
XT615 Question In the last year before [he/she] died, on how many different occasions did [{Name of the deceased}] stay in a hospital, hospice or nursing home?
XT016 Question During the last year of [his/her] life, for how long altogether did [{Name of the deceased}] stay at hospitals, hospices or nursing homes?
XT017 Question INTRODUCTION EXPENSES MEDICAL CARE
XT018 Question HAD TYPE OF MEDICAL CARE IN THE LAST TWELVE MONTHS
XT119 Question COSTS OF TYPE OF MEDICAL CARE IN THE LAST TWELVE MONTHS
XT105 Question We would like to k now more about the difficulties people have in their last year of life because of a physical, mental, emotional or memory problems. During the last year of[his/her] life, did [{Name of the deceased}] have any difficulty remembering where [he/she] was? Please name only difficulties that lasted at least three months?
XT106 Question During the last year of [his/her] life, did [{Name of the deceased}] have any difficulty remembering what year it was? (Please name only difficulties that lasted at least three months?)
XT107 Question During the last year of [his/her] life, did [{Name of the deceased}] have any difficulty recognizing family members or good friends? (Please name only difficulties that lasted at least three months?)
XT020 Question Because of a physical, mental, emotional or memory problem, did [{Name of the deceased}] have difficulty doing any of the following activities during the last twelve months of [his/her] life? Please name only difficulties that lasted at least three months.
XT022 Question Think ing about the activities that the deceased had problems with during the last twelve months of [his/her] life, has anyone helped regularly with these activities?
XT023 Question Who, including yourself, has helped mainly with these activities? Please name at most three persons.
XT024 Question Overall, during the last twelve months of [his/her] life, for how long did the deceased receive help?
XT025 Question And about how many hours of help were necessary during a typical day?
XT620 Question INTRODUCTION DIFFICULTIES
XT622 Question Thinking about the activities that [ {Name of the deceased}] had problems with during the last twelve months of[ his/ her] life, has anyone helped regularly with these activities? ANYONE HELPED WITH ADLII
XT623 Question Who, including yourself, has mainly helped with these activities? Please name up to three persons.WHO HAS HELPED WITH ADLII
XT624 Question Overall, during the last twelve months of [ his/ her] life, for how long did [ {Name of the deceased}] receivehelp?
XT625 Question And about how many hours of help did [ {Name of the deceased}] receive during a typical day?HOURS OF HELP NECESSARY DURING TYPICAL DAY
XT026a Question INTRODUCTION TO ASSETS
XT026b Question Some people mak e a will to determine who receives what parts of the estate.Did [{Name of the deceased}] have a will?
XT027 Question Who were the beneficiaries of the estate, including yourself?
XT030 Question Did the deceased own [his/her] home or apartment - either in total or a share of it?
XT031 Question After any outstanding mortgages, what was the value of the home or apartment or the share of it owned by the deceased?
XT032 Question Who inherited the deceased's home or apartment, including yourself?IWER:Code relationship to deceased.
XT053 Question IWER:First names of children who inherited home
XT033 Question Did the deceased own any life insurance policies?
XT034 Question VALUE OF ALL LIFE INSURANCE POLICIES
XT035 Question Who were the beneficiaries of the life insurance polices, including yourself.
XT054 Question IWER:Specify other relative
XT055 Question IWER:Specify other non-relative
XT056 Question IWER:First names of children who were beneficiaries
XT036 Question INTRODUCTION TYPES OF ASSETS
XT637 Question Did [he/she] own any [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stock s/jewelry or antiquities]?
XT638 Question About what was the value of the [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stock s/jewelry or antiquities] owned by [{Name of the deceased}] at the time of [his/her] death?
XT040a Question TOTAL ESTATE DIVIDED AMONG THE CHILDREN
XT040b Question Would you say that some children received more than others to make up for previous gifts?
XT040c Question Would you say that some children received more than others to give them financial support?
XT040d Question Would you say that some children received more than others because they helped or cared for the deceased towards the end of [his/her] life?
XT040e Question Would you say that some children received more than others because of other reasons?
XT041 Question Finally, we would lik e to k now about the deceased's funeral. Was the funeral accompanied by a religious ceremony?
XT108 Question ANYTHING ELSE TO SAY ABOUT THE DECEASED
XT042 Question This is the end of the interview. Thank you once again for all the information you have given us. It will prove extremely useful in helping us to understand how people fare atthe end of their lives
XT043 Question INTERVIEW MODE
XT044 Question INTERVIEWER ID